Basic Information
| Provider Information | |||||||||
| NPI: | 1952675605 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRIS SIMOPOULOS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7575 W LOWER BUCKEYE RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850433450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027904610 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7575 W LOWER BUCKEYE RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850433450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239075952 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2012 | ||||||||
| LastUpdateDate: | 03/20/2013 | ||||||||
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| AuthorizedOfficialLastName: | SIMOPOULOS | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 6027904610 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305S00000X | L-1730351-7 | AZ | Y | Managed Care Organizations | Point of Service |
No ID Information.